[Hiring] Pro Fee Quality Team Lead @Guidehouse

Role Description

The Lead will be responsible for assisting with the onboarding and training of pro fee reviewers to include but not be limited to:

• Resource tools
• Drives where facility guidelines are stored
• One Note
• Replicon
• Education portal
• P&P’s
• Client specific policies

The Lead will also:

• Create client review training workflows and associated training materials as needed.
• Collaborate with coding operations leaders and oversee the pro fee QA pre-bill assignments.
• Assist with reviewer connectivity process for new or existing clients and troubleshooting with the review team for resolution.
• Collaborate with onshore and offshore coding leadership to update the pro fee review assignment sheet and distribute to the review team weekly.

The Pro Fee quality reviewer will be responsible for:

• Reviewing the entire patient record documentation for the date of service being audited to validate the accuracy of code and abstract data elements.
• Validation of the applicable code elements.
• Ensuring coding quality review number of accounts per coder (as noted on review assignment list) for each coder’s work is completed monthly.
• Conducting coding quality reviews to identify abstracting, ICD-10-CM, CPT, modifier, and HCPCS coding errors for codes assigned by the coding team.
• Running coder productivity reports (where applicable) from the facility system, GuideAudit production or pulling random sample accounts from the completed coding spreadsheet for review.

Qualifications

• Must hold one of the following active credentials: CPC, COC, CPMA, RHIT, RHIA, CCS, CIC, or COC.
• Must have a high school diploma/GED. Relevant experience accepted in lieu of a degree.
• Must maintain coding credentials while employed by Guidehouse.
• Must pass Guidehouse coding competency exam.
• Must have at least 8 years of pro fee coding or review experience.
• Abide by all client policies and procedures.
• Abide by all Guidehouse policies and procedures.
• Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service.
• Ability to work with Microsoft Office, Excel, and computer programs as well as company specific programs.

Requirements

• Auditing experience is preferred.
• Previous leadership experience.
• BS/BA is preferred.

Benefits

• Medical, Rx, Dental & Vision Insurance
• Personal and Family Sick Time & Company Paid Holidays
• Position may be eligible for a discretionary variable incentive bonus
• Parental Leave
• 401(k) Retirement Plan
• Basic Life & Supplemental Life
• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
• Short-Term & Long-Term Disability
• Tuition Reimbursement, Personal Development & Learning Opportunities
• Skills Development & Certifications
• Employee Referral Program
• Corporate Sponsored Events & Community Outreach
• Emergency Back-Up Childcare Program